As mentioned before not all facilities have the ability to simulcast on 121.5 and 243 ... Both are often referred to as "guard". Usually civilian traffic stays on the VHF spectrum so it is hard for a artcc, tower,.. etc.,etc. to check the UHF 243 so when a military aircraft is in their control they will usually request the aircraft to do a radio check on 243.
Why 243? what is 121.5 X 2 ? 243 of course. The logic for this is that the wavelength for 121.5 is so long that the antenna on an elt will sometimes bleed over to 243 because the antenna is usually a 1/4 wave or less on 121.5... this tends to make the antenna resonate on 243 (of course this depends on the specific length of the antenna and quality of the transmitter)
After sept 11 it became mandatory to monitor 121.5 if you had the capability eg spare radio. (better pilots were already doing that) This is one of the reasons why gaurd is more active with accidental transmissions.
This is a good thing as the sarsat's are going to be decomissioned and the coast guard has already posted a message that says they will (if they havent already) stop supporting epirbs OBTW the majority of the older epribs run on 121.5 / 243...